Has Obesity Research Failed?

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I frequently encounter the argument that obesity research has failed because it hasn't stopped the global increase in obesity rates.  According to this argument, we need to re-think our approach to obesity research because the current approach just isn't working.

Grant funding for obesity research keeps increasing in the US, and the prevalence of obesity also keeps increasing*.  What gives?  Maybe if we just scrapped the whole endeavor we'd be better off.

Let's take a closer look at this argument and see how it holds up.

Why Do Research?

There are two fundamental reasons why we do research:
  1. To gather accurate information about the natural world.  This information is intrinsically valuable because we like knowing how the world works, and it may eventually have practical value that's not immediately obvious.
  2. Practical applications.  We want to solve problems and improve our lives.
If we want to determine whether or not obesity research has failed, we should evaluate it using those two metrics.

Has Obesity Research Gathered Accurate Information?

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Food Reward Friday

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This week's lucky "winner"... Lay's milk chocolate-dipped potato chips!!


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A New Understanding of an Old "Obesity Gene"

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As you know if you've been following this blog for a while, obesity risk has a strong genetic component.  Genome-wide association studies (GWAS) attempt to identify the specific locations of genetic differences (single-nucleotide polymorphisms or SNPs) that are associated with a particular trait.  In the case of obesity, GWAS studies have had limited success in identifying obesity-associated genes.  However, one cluster of SNPs consistently show up at the top of the list in these studies: those that are near the gene FTO.

As with many of the genes in our genome, different people carry different versions of FTO.  People with two copies of the "fat" version of the FTO SNPs average about 7 pounds (3 kg) heavier than people with two copies of the "thin" version, and they also tend to eat more calories (1, 2).  

Despite being the most consistent hit in these genetic studies, FTO has remained a mystery.  As with most obesity-associated genes, it's expressed in the brain and it seems to respond somewhat to nutritional status.  Yet its function is difficult to reconcile with a role in weight regulation: 
  • It's an enzyme that removes methyl groups from RNA, which doesn't immediately suggest a weight-specific function.
  • It's not primarily expressed in the brain or in body fat, but in all tissues.
  • Most importantly, as far as we know, the different versions of the gene do not result in different tissue levels of FTO, or different activity of the FTO enzyme, so it's hard to understand how they would impact anything at all.  
An important thing to keep in mind is that GWAS studies don't usually pinpoint specific genes.  Typically, they tell us that obesity risk is associated with variability in a particular region of the genome.  If the region corresponds to the location of a single gene, it's a pretty good guess that the gene is the culprit.  However, that's not always the case...

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Fat vs. Carbohydrate Overeating: Which Causes More Fat Gain?

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Two human studies, published in 1995 and 2000, tested the effect of carbohydrate vs. fat overfeeding on body fat gain in humans.  What did they find, and why is it important?

We know that daily calorie intake has increased the US, in parallel with the dramatic increase in body fatness.  These excess calories appear to have come from fat, carbohydrate, and protein all at the same time (although carbohydrate increased the most).  Since the increase in calories, carbohydrate, fat, and protein all happened at the same time, how do we know that the obesity epidemic was due to increased calorie intake and not just increased carbohydrate or fat intake?  If our calorie intake had increased solely by the addition of carbohydrate or fat, would we be in the midst of an obesity epidemic?

The best way to answer this question is to examine the controlled studies that have compared carbohydrate and fat overfeeding in humans.

Horton et al.

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Garden Update: A Banner Year

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Things are warming up here in Seattle and the flowers are blooming.  I just planted my first crops of the year-- potatoes and strawberries.

2013 was a banner year for my 500-square-foot urban vegetable garden, including my first experience growing and processing a grain.  I never got around to posting about it last year-- so here it is.

Interbay mulch technique

The bed on the right has been mulched with leaves, spent coffee
grounds, and burlap sacks ($1/sack at the local hardware store).
The beds on the left were planted with a rye-clover-vetch-pea
cover crop.  Paths are mulched with wood chips.
In the fall of 2012, I tried a new technique for improving the soil called "Interbay mulching".  This is a variation on sheet mulching, which involves placing uncomposted organic matter directly onto the garden soil in fall and letting it compost until the next growing season.  To Interbay mulch, you simply cover your sheet mulch with burlap.  This keeps everything moist, protects earthworms from bird predation so they can munch freely, and suppresses weeds.  I used leaves (carbon) and spent coffee grounds from a local coffee shop (nitrogen) for my organic matter.

When I pulled back the burlap last spring, I was initially disappointed.  The coffee grounds had disappeared completely, but there was still a lot of leaf matter left on the soil, indicating that it had only partially composted.  However, I later decided that it had worked well, because the soil structure underneath was improved and it seemed to be enriched with significant organic matter as well as a large population of fat earthworms.  The mulch suppressed weeds remarkably well, and the beds remained mostly clean for the rest of the season.

Those observations, combined with huge yields from the mulched beds, convinced me that it was worthwhile.

New tools
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More Graphs of Calorie Intake vs. BMI

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In the last post, a reader commented that the correlation would be more convincing if I graphed calories vs. average BMI rather than the prevalence of obesity.  It was a valid point, so I went searching for average BMI values from NHANES surveys.  I dug up a CDC document that contains data from surveys between 1960 and 2002 (1).  Because these data only cover five survey periods, we only get five data points to analyze, as opposed to the eight used in the last post.  The document contains BMI values for men and women separately, so I averaged the two to approximate average BMI in the general adult population.  It's also worth noting that I use the approximate midpoint of the survey period as the year.

First, a graph of average BMI over time.  It went up:



Now, let's see how well average BMI correlates with calorie intake:


The correlation between calorie intake and obesity prevalence was remarkable, but this correlation is simply incredible.  An R-squared value of 0.98 indicates that daily calorie intake and average BMI are almost perfectly correlated.

We can further deduce that each 100-calorie increase in daily food intake is associated with an 0.62-point increase in average BMI among US adults.  

Calorie Intake and the US Obesity Epidemic

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Between 1960 and 2008, the prevalence of obesity in US adults increased from 13 to 34 percent, and the prevalence of extreme obesity increased from 0.9 to 6 percent (NHANES surveys).  This major shift in population fatness is called the "obesity epidemic".


What caused the obesity epidemic?  As I've noted in my writing and talks, the obesity epidemic was paralleled by an increase in daily calorie intake that was sufficiently large to fully account for it.  There are two main sources of data for US calorie intake.  The first is NHANES surveys conducted by the Centers for Disease Control.  They periodically collect data on food intake using questionnaires, and these surveys confirm that calorie intake has increased.  The problem with the NHANES food intake data is that they're self-reported and therefore subject to major reporting errors.  However, NHANES surveys provide the best quality (objectively measured) data on obesity prevalence since 1960, which we'll be using in this post.

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Uncovering the True Health Costs of Excess Weight

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Is excess weight hazardous to health, or can it actually be protective?  This question has provoked intense debate in the academic community, in some cases even leading researchers to angrily denounce the work of others (1).  There is good evidence to suggest that excess body fat increases the risk of specific diseases, including many of our major killers: diabetes, heart attack, stroke, heart failure, cancer, and kidney failure (2).  Yet strangely, the studies relating excess weight to the total risk of dying-- an overall measure of health that's hard to argue with-- are inconsistent.  Why?
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New Position with Nestlé

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Warning -- Satire -- April Fool's Post

I'm happy to announce that I've accepted a Product Research and Development position with Nestlé Foods.  Nestlé is known for its skillful application of 'neuromarketing'-- using neuroscience to enhance product development and sales-- and the company recruited me for my background in neuroscience and food reward.

As Whole Health Source readers know well, food reward has a major impact on food selection and consumption, and therefore it has huge potential as a product development strategy.  Although product development by the food industry has always relied to some extent on a basic understanding of food reward, corporations still lag far behind the cutting edge of food reward research, and they are therefore missing out on a major opportunity to drive repeat purchase and consumption behavior and increase total sale volume.  I plan to leverage science-corporate synergy to develop food product solutions that people LOVE*.

Even more exciting, Nestlé has asked me to lead a strategic partnership initiative with Coca-Cola to utilize neuromarketing to tailor beverage product development specifically for children, who have a somewhat different set of reward criteria than adults.  We're excited to develop product solutions that kids LOVE* even more than current offerings, by scientifically designing new combinations of flavors, sweeteners, and totally safe habit-forming drugs such as caffeine.

Both companies have been very responsive to my nutritional concerns about processed foods, and so we're working together to make healthier products.  Here are some of the changes we're discussing:
  • Adding vitamin C and cod liver oil to chocolate.
  • Replacing a portion (1.7%) of the sugar in beverages with stevia across the board.
  • Stealthily decreasing the portion size of beverages.  To do this, we'll increase the thickness of the plastic bottles so the exterior of the bottle is the same size, but the actual beverage content is reduced by 0.2 oz.
  • Getting these healthy snacks and beverages back into schools where kids can enjoy them!
One of the first things we discussed is getting the advertising department at Nestlé to write guest posts for Whole Health Source.  This will be a fun way for WHS readers to stay informed of current Nestlé products and what we have coming down the pipeline!

April Fools!!!!!!


* Learned Obedience Via Eating

Corrections to the New Review Paper on Dietary Fat and Cardiovascular Risk

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The meta-analysis by Chowdhury et al. raised quite a furor from certain segments of researchers and the popular media.  I find this reaction interesting.  I usually write about obesity, which is a topic of great interest to people, but my post about the review paper received more than twice my usual traffic.  People whose findings or opinions are questioned by the paper are aggressively denouncing it in the media, even calling for retraction (1).  This resembles what happens every time a high-profile review paper is published that doesn't support the conventional stance on fatty acids and health (e.g., Siri-Tarino et al. [2], which despite much gnashing of teeth is still standing*).  I'm not sure why this issue in particular arouses such excitement, but I find it amusing and disturbing at the same time.  This kind of reaction would be totally out of place in most other fields of science, where aggressive public media outbursts by researchers are usually frowned upon.

As it turns out, the critics have a point this time.  Significant errors were uncovered in the original version of the meta-analysis, which have been corrected in the current version (3).  These include the following two errors, one of which alters the conclusion somewhat:
  • The outcome of one observational study on omega-3 fatty acids was reported as slightly negative, when it was actually strongly positive.  This changes the conclusion of the meta-analysis, making it somewhat more favorable to omega-3 consumption for cardiovascular protection.
  • The authors left out two studies on omega-6 fatty acids.  These didn't change the overall conclusions on omega-6.

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Book Review: Your Personal Paleo Code

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Chris Kresser has been a major figure in the ancestral health community for some time now.  It's funny to recall that I was actually one of his first readers, back in the early days of his blog when it was called The Healthy Skeptic and the audience was small.  Chris's readership rapidly eclipsed mine, and now he's in high demand for his ability to convey ideas clearly and offer practical solutions to important health concerns.

He recently published a book titled Your Personal Paleo Code, which also happens to be a New York Times bestseller.  The primary goal of the book is to help you develop a diet and lifestyle that support health and well-being by starting from a generally healthy template and personalizing it to your needs.  Let's have a look.

Introduction

Kresser opens with the poignant story of his own health problems, which began with an infectious illness in Indonesia and several courses of antibiotic therapy.  After years of struggling with the resulting symptoms, trying a variety of diets, and finally accepting his condition, he was unexpectedly able to recover his health by adopting a personalized Paleo-like diet that included bone broth and fermented foods.

Why Paleo?

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Food Reward Friday

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This week's lucky "winner"...  the Taco Bell waffle taco!!


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The Ultimate Detox: Your Kidneys

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The specter of unseen, unspecified toxins eroding our health is worth many millions of dollars in the United States and abroad.  Companies offer "detox" supplements, beverages, and creams that supposedly rid us of supposed toxins, despite a complete lack of evidence that these products do anything at all*.  This comes from an industry that excels at creating boogeymen and offering costly solutions for them.

If your wallet needs to lose weight, then these products are highly effective, otherwise it's probably best to save your money.  Here's why.

The body is equipped with an extremely advanced system for excreting toxins.  The kidneys are part of this system, and their design is genius.  The basic functional unit of the kidney is the nephron, and the average kidney contains about a million of them.  Nephrons have two major parts: a renal corpuscle and a renal tubule

A nephron.  In this image, the Bowman's capsule and glomerulus make up the renal corpuscle, and the proximal/distal tubules and the loop of Henle (#1-3) make up the renal tubule.  Note the network of blood vessels (capillaries) that allow the transfer of water and other goodies from the tubule back into the blood.  Image source.
The renal corpuscle is the interface between the blood and the fluid that will eventually become urine.  Blood is filtered by a fine "sieve" of cells that prevents everything larger than a small protein from passing into the renal tubule.  Red blood cells, platelets, and most proteins stay on the blood side, while small proteins such as albumin, minerals, urea, glucose, water, and almost anything that would be considered a toxin** are allowed through into the renal tubule.

The renal tubule is a long tube that re-absorbs everything in this filtered blood that the body wants to keep.  Water, minerals, albumin, glucose, amino acids, and other useful molecules are re-absorbed.  Everything else ends up as urine and is excreted. 

Can you see the genius of this design?  Urine is blood, minus all the good stuff.  Everything that isn't specifically recognized by the body as useful is excreted by default, no matter what it is.  The body doesn't have to recognize each of the thousands of foreign compounds that make their way into our circulation each day.  These substances are all out the door, by default.

Are you impressed by your kidneys yet?  If not, consider this.  Your kidneys filter your entire blood volume roughly 70 times per day.  The reason you don't have to pee a liter a minute is that urine volume is reduced by 99 percent due to water reabsorption in the renal tubules.

This is why most drugs have to be taken on a regular basis, often several times per day.  In concert with the detoxification enzymes of the liver, which tend to make drugs easier for the kidneys to excrete, the kidneys rapidly reduce the circulating concentration of drugs simply by excreting everything they don't recognize as useful.

Can a detox product improve upon 500 million years of kidney evolution***?  I have my doubts.


* Exception: chelation therapy offered by a licensed medical practitioner for actual, diagnosed heavy metal poisoning.  Second exception: strategies that use the word "detox" loosely to refer to removing unhealthy foods from the diet.

** Toxins tend to be very small-- either small organic molecules or minerals such as arsenic.  Larger toxins such as proteins are uncommon in the circulation because proteins are generally not absorbed by the digestive tract.  Toxic proteins have to be injected or otherwise directly introduced into the circulation, e.g. by a snake bite or a bacterial infection.  But if you're bitten by a rattlesnake, I hope your first line of treatment won't be a detox kit from your local supplement store.

*** Kidneys are present in hagfish and lampreys, the most "primitive" living vertebrates.